中老年代谢综合征患者合并冠心病对肾功能的影响研究

Influence of Metabolic Syndrome Complicated With Coronary Heart Disease on Renal Function on the Middle-aged and Elderly Patients

目的探讨中老年代谢综合征(MS)患者合并冠心病(CHD)对肾功能的影响。方法选取2014年7—12月在淮安市第二人民医院接受《淮安城区2型糖尿病防治方案研究》相关体检的在职和退休职工3 676例。以确诊为MS的1 988例为病例组,根据是否合并CHD分为MS组(n=1 811)和MS+CHD组(n=177);以无CHD和MS的1 688例为对照组。收集并比较3组受试者的一般资料,采用多元线性回归分析、多因素Logistic回归分析探讨MS患者肾小球滤过率估计值(e GFR)、合并慢性肾脏病(CKD)的影响因素。结果 3组性别、平均年龄、吸烟、饮酒、BMI、腰围(WC)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、ALT比较,差异有统计学意义(P<0.05);AST比较,差异无统计学意义(P>0.05)。3组合并CKD比例、血肌酐(SCr)、尿素氮(BUN)、e GFR比较,差异均有统计学意义(P<0.05)。多元线性回归分析结果显示,性别、年龄、饮酒、SBP、FPG、Hb A1c、TG、LDL-C、ALT及合并CHD对MS患者e GFR的影响有统计学意义(P<0.05);矫正混杂因素后,性别、年龄、饮酒、FPG、TG、LDL-C及合并CHD对MS患者e GFR的影响有统计学意义(P<0.05),合并CHD可导致MS患者e GFR下降约4.094 ml·min-1·(1.73 m2)-1。多因素Logistic回归分析结果显示,性别、年龄、TC、LDL-C及合并CHD对MS患者合并CKD的影响有统计学意义(P<0.05);矫正混杂因素后,性别、年龄、TC、LDL-C及合并CHD对MS患者合并CKD的影响有统计学意义(P<0.05),合并CHD MS患者的CKD发生风险是单纯MS患者的2.043倍。结论CHD可加重MS患者的肾功能损害,临床应重视对合并CHD MS患者的肾功能评估。

Objective To explore the influence of metabolic syndrome（ MS） complicated with coronary heart disease（ CHD） on renal function on the middle- aged and elderly patients. Methods From July to December 2014,we selected 3 676in- service and retired employees who had received physical examination test related to ＂ type 2 diabetes prevention study on Huai＇an City＂ in Huai＇an Second People＇s Hospital. 1 988 cases of diagnosed with MS in the case group and 1 688 cases of no CHD and MS in the control group. The case group were divided into MS group（ n = 1 811） and MS ＋ CHD group（ n = 177）according to whether complicated with CHD. We collected and compared the three groups of participants ＇ general information. Using multiple linear regression analysis to investigate the influencing factors of estimated glomrular filtration rate（ e GFR） in MS patients and using multivariate Logistic regression analysis to investigate the influencing factors of MS patients complicated with chronic renal diseases（ CKD）. Results Three groups were significantly different in gender,average age,smoking,drinking, BMI, waist circumference（ WC）, systolic blood pressure（ SBP）, diastolic blood pressure（ DBP）,fasting plasma glucose（ FPG）,glycosylated hemoglobin（ Hb A1c）,total cholesterol（ TC）,triglyceride（ TG）,low density lipoprotein cholesterol（ LDL-C）,high density lipoprotein cholesterol（ HDL-C） and ALT（ P〈0. 05） and were not significantly different in AST（ P〈0. 05）. Three groups were significantly different in proportion of combined with CKD,serum creatinine（ SCr）,blood urea nitrogen（ BUN）,e GFR（ P〈0. 05）. Multiple linear regression analysis showed that gender,age,drinking,SBP,FPG,Hb A1 c,TG,LDL-C and ALT complicated CHD were significantly different in influencing of e GFR in MS patients（ P〈0. 05）. After correcting confounding factors,gender,age,drinking,FPG,TG,LDL-C and complicated with CHD were significantly different in influencing of e GFR（ P〈0. 05）. Complicated with CHD can lead to MS patients in e GFR decreased by roughly 4. 094 ml·min- 1·（ 1. 73 m2）- 1. Multivariate Logistic regression analysis showed that gender,age,TC,LDL-C and complicated with CHD were significantly different in MS patients complicated with CKD（ P〈0. 05）. After correcting confounding factors, gender, age, TC, LDL-C and complicated with CHD were significantly different in MS patients complicated with CKD（ P〈0. 05）. The risk of CKD in MS patients complicated with CHD was 2. 043 times that in simple MS patients. Conclusion CHD can aggravate the damage of renal function in MS patients. The clinical value should be paid attention to the renal function evaluation of MS patients complicated with CHD.